Is it ethical to get a booster shot when so many people in the world can't even access their first dose?

The same week that Rochelle Walensky, the director of the Centers for Disease Control and Prevention, gave the green light to booster shots for Pfizer vaccine recipients over age 65, the World Health Organization reported that only 2.2% of people in the world’s low-income countries had received even one dose of a Covid vaccine.

That means millions of Americans will receive a third vaccine dose while billions around the world have not had their first.

That stark contrast of U.S. haves and global have-nots prompted one of my clinic patients to ask me, “Is it immoral for me to get a booster?”

My response is in my new article at Boston Globe’s STAT news: https://www.statnews.com/2021/10/15/feeling-guilty-about-getting-covid-booster-shot-do-this/

Scientific transparency - like vaccines - has short-term side effects but they are worth the massive long-term benefits

I recently met hundreds of COVID-19 vaccines at the door of Vermont's large public vaccination drive, shepherding each one to meet the nurses who would perform the vaccination.

I screened each for symptoms of active disease, commented on the lovely spring weather, and asked if they had any concerns.

One nattily dressed Black woman in her mid-forties admitted she was nervous as we walked toward her chair.

"I hate needles," she said, visibly shaking. "Are these vaccines safe?"

We paused. I listened. I said I was glad she had come. I reassured her that I believe, as a physician, that COVID-19 vaccination will make her much safer than she was before.

In Europe, recent reports of extremely rare clotting complications of the AstraZeneca vaccine made European vaccine recipients markedly more nervousabout vaccine safety. Many public health authorities worried public safety fears could hurt efforts to vaccinate past a fourth wave of COVID-19 deaths.

I think it’s worth it, though, ,to be transparent. Like vaccines, scientific transparency has real short-term side effects but they are well-worth the mammoth long-term benefits.

To read more, check out my new post about how scientific transparency, like vaccines, has short-term side effects up at MedPage TODAY.

Cutting corners on a coronavirus vaccine could cost lives

In the desperation to save lives in the coronavirus pandemic, we have already begun to relax scientific standards in the hope of finding a treatment without waiting to prove that it works.

Bioethicists have proposed risky human-challenge trials — which expose volunteers to the virus — to speed coronavirus vaccine development, and the Trump administration has already let one vaccine maker skip the usual requirement for animal safety trials before injecting an unproven vaccine into the arms of human volunteers.

The World Health Organization has funded a trial of new drug therapies that shockingly has no placebo-control arm.

And, of course, the experimental and potentially dangerous use of hydroxychloroquine in Covid-19 patients already boasts the presidential seal of approval and has become commonplace in American hospitals.

The next scientific corner to cut is clear.

Influential authors from the Coalition for Epidemic Preparedness Innovations recently wrote in The New England Journal of Medicine that “in a high-mortality situation, populations may not accept randomized, controlled trials with placebo groups.” While placebo-controlled multivaccine trials may be one solution, they wrote, another would be to skip the placebo.

This wouldn’t be the first time doctors took a chance on an unproven vaccine on a mammoth scale.

Read more in my new article at The New York Times.

Why volunteer for a vaccine study?

Despite a legacy of scientific misconduct,and the usual complexities of conducting science across cultural differences, people in countries across the world volunteer for vaccine studies. 

Why? What motivates them? What are their fears?

Medical anthropologist Sienna Craig, I and our esteemed colleagues recently investigated. Check out our new paper, here in BMC Public Health.

What's the best way to incentivize immunizations?

Vaccination saves lives.

Yet, resistance to immunization has become entrenched in some sociodemographic strata. Wealthy, educated liberals who care about organic food and "natural" products among them. 

Under-immunization of school-aged children in turn has led to outbreaks of measles and other transmissible infections, and contributes to  thousands of preventable influenza deaths in children each year. 

It's not enough to tout the benefits of vaccines, and then stand back with syringe in hand. Potential vaccines want to know vaccines are safe, and hear misconceptions about the low risks of vaccines. A seminal article by my Dartmouth colleague Brendan Nyhan showed that trying to disabuse vaccine skeptics of their misconception too may fail. 

Many states and countries are piloting various incentive programs designed to enhance immunization rates without engaging in potentially polarizing debate. From making immunizations mandatory to attend school to linking welfare benefits to vaccine receipt and even straight up cash incentives, lots of experiments are happening. Some of them even work.

Check out this great article by Susan Scutti of CNN and its accompanying video. I was proud to be quoted in it.

Vaccines just aren't as easy to discover as they used to be

Edward Jenner had it easy. Swab some cowpox in 1796, scratch the nastiness into the arm of a little kid (see below), and, PRESTO, instant immortality. 

Vaccine success after vaccine success followed. Measles, mumps, rubella, polio... one after another global scourge quaked before the mighty pipettes of vaccine researchers.

I admit, the stalwarts who discovered those vaccines did more than transfer cow-pus to an un-consented minor research subject prior to doing a victory lap around the farm. Rather, they earned their laurels by working hard, and by being brilliant.

But ease wrought hubris, and as deadly viral menaces fell in succession, you could forgive one noted twentieth century sage, US Surgeon General William Stewart (pictured below), for saying, "It’s time to close the books on infectious diseases, declare the war against pestilence won, and shift national resources to such chronic problems as cancer and heart disease."

Whoops!

These early triumphs gave way to a long, hard slog. Vaccines against HIV, tuberculosis, herpes, staphylococci, and hepatitis C, among others, have proven far more elusive. Amid small successes, and spectacular failures, we have discovered an uncomfortable fact: we don't really know what makes a good vaccine tick. 

This week I was glad to contribute both heat and noise to the mix. In an op-ed in the Health Affairs blog, I write about the dangers of dogmatism and the lessons learned on the road to a new HIV vaccine. And, we also published preclinical data this week on a new scalable version of our tuberculosis vaccine. Data from our Phase 1 trial of the same vaccine should come out soon!

Who knows if all this will lead to glory. Probably not! Either way, it's been a pleasure to try. 

Pervasive HPV myths that keep us from preventing cancer

Human papillomavirus causes hundreds of thousands of cases of cancer each year, yet the uptake of safe vaccines to prevent those cancers has been mindbogglingly slow.

I was glad to be quoted in a Reader's Digest story called "10 Myths About HPV That Could Seriously Damage Your Health."

Is the new Ebola vaccine too good to be true?

Ebola is on the run: the number of cases dipped below ten a week recently, and a few days ago investigators announced in the prestigious journal The Lancet that a new Ebola vaccine was “100% effective.”

In response, global health authorities are starting to sound a little giddy. “We believe that the world is on the verge of an efficacious Ebola vaccine,” said Marie Paule Kieny, the World Health Organization’s assistant director-general for health systems and innovation (and a senior author on the paper). “It could be a game changer.”

She’s right: this is wonderful news, and a great testament to human ingenuity. A genetically engineered hybrid of the benign vesicular stomatitis virus and the Zaire strain of Ebola, together called rVSV-ZEBOV, was tested in a multi-site clinical trial conducted amid a massive aid response in Guinea, one of the poorest countries in Africa. The scientific and logistical acrobatics required to pull this off boggle the mind.

Yet, for three reasons, we cannot know if the vaccine really worked, or how well. 

To read more, check out my new post over at The Conversation.